Lower and Upper Eyelid Surgery and How It Delivers Natural Results

Lower and upper eyelid surgery is not just about removing the excess skin and fat. A more important objective is to rejuvenate one’s appearance without resulting in surgical stigmata such as visible scars and “skeletonized” eye socket.

Celebrity Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a Snapchat video to demonstrate how the “right” techniques in lower and upper eyelid surgery can deliver natural-looking, rejuvenated results that are almost near permanent.

The patient shown in the video has loose skin in her upper lid; this “heaviness” has some effect on her vision. She also has “crepe-like” skin and excess fat in her lower lid that further contributed to her aged appearance.

Dr. Smiley first performed the upper eyelid surgery by creating an incision pattern whose resulting scar would lie precisely at the existing eyelid fold to avoid surgical stigmata. He removed a larger amount of skin tissue (compared to “average” patients) because of her rather significant ptosis (droop).

Aside from removing the excess skin, the surgeon also excised a small piece of muscle and fat to further eliminate the “fullness.” It is important to note that the upper eyelid surgery has no margin of error—i.e., removing more than the intended amount of tissue can lead to “incomplete blink” and ultimate result in a wide range of problems such as lid retraction, dry eye syndrome, and irritation.

“Before surgery marking is done in standing position because everything shifts [when one is in supine position] so I can accurately assess how much skin removal is ideal,” he says.

After removing the excess skin, he also excised a small piece of muscle and fat. Nonetheless, some fat must remain after surgery to avoid the skeletonized appearance, which is nothing close to looking natural, he further explains.

Dr. Smiley then proceeded with the lower eyelid by creating a small incision very close to the lower lash line so the resulting scar would be perfectly concealed. In this procedure, he also removed a small piece of excess skin and “isolated” a tiny portion of fat that was later excised.

To prevent an abrupt transition between the lower eyelid and upper cheek, the surgeon injected fat graft into the tear trough. This additional procedure could also make the results more “stable” and would resist the effects of continuous aging.

Apart from proper scar placement, wound closure is also critical to hide any surgical stigmata. For this reason Dr. Smiley uses very fine sutures that are smaller than the human hair when closing the incisions.